The Health Insurance Claim Plain Language and Simplification Act mandates that health insurance carriers in New Jersey provide a written explanation of benefits (EOB) form to covered individuals whenever a claim is processed. This EOB must include specific information on its first page, such as the insured's name, healthcare provider's name, date of service, claim amount, amount paid by the carrier, and the amount owed by the covered person. Additionally, if a claim is partially or fully paid, the EOB must explain the reasons for that decision, and if denied, it must provide the reasons for denial. The form must also include instructions for any required actions or options available to the covered person regarding the claim.

Furthermore, the bill stipulates that the first page of the EOB form should contain only the specified information and be presented in a 12-point font using simple, plain language that is easily understandable. This requirement aligns with the standards set by the Life and Health Insurance Policy Language Simplification Act. The act is set to take effect 90 days after its enactment.